Institutional providers are faced with a maze of regulations regarding rate setting and reimbursement methodologies. Each provider classification has unique rules and restrictions which govern reimbursement. With all the regulatory changes that occur within each of the payer types, navigating this maze is very cumbersome.
PCG Health consultants have extensive experience with CMS rate setting requirements and provide clients with unmatched rate setting services, including but not limited to
Charge sensitivity analysis to identify opportunities to make changes to the facility CM to maximize reimbursement from charge-based payer through optimization of the facility charge structure;
Development of rates for reimbursement on a cost basis for IP ancillary services and Physician services;
Reviews providers Medicare Wage Related Cost detail to ensure all allowable wage related salary, fringe benefits, contract labor and Physicians costs are properly captured;
Preparation of TEFRA appeals for cost reports not impacted by the BBA or the BBRA;
Calculation of cost based rates for public providers to maximize compliance with State Plan methodologies and improve reimbursement to the facility.
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For more information about PCG Health's Rate Setting Services please contact us at firstname.lastname@example.org or 1-800-210-6113.